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one dimensional. T ey are usually pushing a product that is not all inclusive. We have to think about many situations. We cannot assume that only a hurricane will hit our facility just because we are in Sarasota. Many disasters occur without any kind of notice. We could face other problems like a grid power outage, a tornado strike, a plane crash, etc. T ese are all scenarios where we are required to keep our systems online and operating. We have found that by talking to these specialty vendors that

very few of them are adaptable to the many contingences that a hospital technology group might face. Most of them have a service where they deliver to your site a truck or several trailers where they have servers and PCs for you to get back up and running. In our case, our needs are far greater than that. Medicine these days has become more and more dependent on information systems. T e products and services of specialty companies usually take time to initiate, but we do not have the luxury of waiting. We can’t wait for that trailer to show up. We can’t wait for those servers to be spun up. We can’t wait for those PCs to be put in place. T ere has to be something already in place and ready to go. We have found very few partners who have wanted to guarantee that kind of delivery and service level.

When disaster strikes, how do you move into action?

Let’s use the obvious choice for us, a hurricane, as an example. For that situation, we have two teams. One team, Team A, is responsible for working during the event. T e second team, Team B, is responsible for all the work after the event. Team A is based inside the facility during the event and facilitates the technology continuity of our systems. T ey meet the information needs of any staff member whether they are outside at an ancillary location or inside our local facility. Once the hurricane passes, Team B comes in to relieve Team A.

Team B will restart any systems that had to be taken down during the event. T ey also recover any lost data, and they get things back in normal working order. Whatever is initiated by Team A, it is fi nished by Team B until the eff ects of the disaster are mitigated. Of course, there are other precautions that are taken if we are

preparing for a hurricane where there is a likelihood of a storm surge. Where possible, we will move computers ahead of time to a higher location (off the fl oor). However, unlike many businesses, we do not have the luxury of turning off our systems during a disaster, so we do our best to place our technology devices in a safe location where they can be utilized. T e drills we run through on a yearly basis help us to be as prepared as we can be when a disaster strikes.

What are the types of drills or simulations that you undergo to prepare for a disaster?

At our hospital, in addition to simulating medical disasters where we prepare for the treatment of a surge of causalities, we simulate situ- ations where we experience a loss of data. During these simulations, we fi re up our secondary site while the medical personnel are working on their particular drills. We also simulate power outages where we would experience a complete loss of our systems inside the hospital. We have an Emergency Management Committee that meets once a month to discuss the fi ndings of our simulations and any possible revisions that need to be made to our disaster recovery plans. We discuss what systems and practices need to be re-tested based upon the fi ndings and observations of representatives on the committee. T ese representatives discuss the tests that have been run and what holes, if any, they have found. Discussions then revolve around possible solutions and improvement plans. We always strive for improvement.

Do you ever evaluate the practices used at other hospitals to modify your own plans?

Yes, our Emergency Management Committee meets quite often to review reports from hospitals that have experiences with events such as Hurricane Sandy or tornados in Oklahoma. We create a “lessons learned” report that helps us to see how we might need to make ad- justments to our own emergency planning. What did they learn, and what did they experience that may be similar to our facility’s plan? We incorporate those experiences and fi ndings into our own practices. Even if we have not experienced those sorts of events fi rst hand, they do aff ect our plans and decision making.

What is an example of a practice currently in place at your hospital that was created as a result of these meetings?

We created a mobile emergency triage data information system that can be deployed to the fi eld that facilitates the tagging and triaging of patients away from our facility such as when the area may experience an airline disaster or building collapse. During a disaster, there are a number of diff erent types of victims: the walking wounded with minor injuries, those who are not ambulatory, fatalities, etc. All of these situa- tions require the gathering of important information that will be placed within our main information system either when the hospital system goes back online or when those fi eld doctors return to the hospital. For this need, our committee found a gap between our needs and the products or services off ered in the industry, so we fi lled it ourselves by creating the necessary interface to bridge several systems. Another good example is this one. Let’s say we are in a situation

where we lose all of our patient information like those relative to patient charts and medication. Let’s say all of the servers go down and there is no way to get patient information on a particular fl oor. Our care providers, our doctors and nurses, cannot get the information they need. T at is a huge hole that no a single company has been able to fi ll. We fi lled it ourselves by developing our own solution. We are

now able to send encrypted patient information to a device on each of the fl oors of our facility. Even if all the power is out, all we need is temporary power to this computer, and a nurse can punch in the key code and immediately have access to all the patient chart information. T ere is a printer nearby where the information can be printed and then used for patient care on the fl oor. As far as I know, there is not a single company out there that has anything like this available. T at is something we had to invent ourselves.

Unlike most businesses during a disaster that only have to mitigate damage and restart their operations, hospitals have to also prepare for a surge in patient need, both inside the facility and in the fi eld. How do you make plans to handle this surge of work?

In this case, the technology in the marketplace does help. T ere is a company called Disaster Management Systems who produces a prod- uct called Triage Tags, which is a portable IT system that can be run on a single laptop. It is a tool that is used to tag patients in the fi eld. However, there is no way to import that information into your main patient information system. We have to create that interface on our own, so there was a gap. We had to write an interface between their system which sits on a laptop and our main enterprise patient information system. As in most cases, we rely on outside vendors for our products but we cannot rely upon them for creating processes to use their tools during a disaster or surge situation. We have internal processes and programs to manage a medial surge situation. I have already mentioned the information technology con- tinuity plans involving Teams A and B. However, every department in